Five Questions With: Linda Hurley

Linda Hurley, president and CEO of CODAC Behavioral Healthcare, was presented with a Lifetime Achievement Award by the Aquidneck Rally 4 Recovery committee Sept. 8 at Pottsy Field in Middletown.

Rally4Recovery is the largest event of the year organized to spread awareness and compassion for people in recovery. CODAC has joined other organizations at this yearly gathering to remember those who have been lost to the opioid crisis and to recognize individuals who are still in treatment and recovery.

Hurley was instrumental in partnering with the R.I. Department of Corrections to implement an opioid treatment program that was touted as a national model by Brown University faculty. She also spearheaded efforts to attain Center of Excellence designations for all CODAC sites.

PBN: Coverage of the national opioid addiction epidemic seems comprehensive. What, if anything, about the problem isn’t getting the attention it deserves?

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HURLEY: Most of the news coverage that has focused on the opioid epidemic has focused on the scope and depth of this public health concern. While it is important to highlight this aspect of the crisis, most clinicians would agree that we haven’t done enough to destigmatize opioid use dependence.

When individuals check into one of CODAC’s facilities, our team of clinicians and counselors help patients determine the best course of action to help manage their addiction. During some of these meetings, patients have said they avoided treatment because they felt people close to them would have judged them negatively or viewed them differently.

A recent government survey lends credence to these types of statements. Using statistics from 2016, the survey results suggested that roughly 2 million people in the United States have an opioid use disorder, while emphasizing that the actual number may be higher because people don’t want to share details about their disorder over the phone, where others could overhear, or be seen entering a treatment facility.

It should also be noted that stigma is demonstrated in more subtle ways, such as the extreme regulation of treatment for addiction when compared to treatment for more common conditions. We see it manifested in the attitudes of the medical community when doctors are uncomfortable asking questions that might identify a substance use disorder. Others within the medical community have not yet accepted that addiction is a chronic, relapsing disease.

Finally, stigma is clearly demonstrated by the fact that reimbursement rates for addiction treatment are significantly lower than for the treatment of other, often less high-risk, medical conditions, and that rates have not been adjusted for years, even as the cost of treatment continues to rise. The need for emergency funding for addiction treatment might be considerably reduced if providers were reimbursed at a rate commensurate with other specialties.  This disparity must be addressed at the state and federal levels.

PBN: How much of state and federal efforts are aimed at curbing the root causes of the epidemic? What would you do more of or differently?

HURLEY: It is difficult to give an estimate of the government efforts that are directly addressing the root causes of the opioid epidemic. What I can say is that newer legislative measures such as the ones introduced in CARA 2.0, co-authored by Sen. Sheldon Whitehouse, are aimed at limiting the prescription of opioid-based painkillers such as oxycodone, improving access to and increasing capacity for care, and holding pharmaceutical companies accountable for their ongoing role in the crisis.

These policy changes will undoubtedly help curb the crisis, but there are other ways we can use federal dollars more efficiently. For instance, if you look at government statistics, the leading cause of death for former inmates is drug overdose, especially during the first weeks following their release. To address this issue, CODAC partnered with the R.I. Department of Corrections to offer inmates access to medication assisted treatment during incarceration.

Because these individuals are stabilized on medication prior to release, they are more likely to seek and continue their treatment when they re-enter the community. Researchers from Brown University found that a 12 percent decrease in the number of overdoses across Rhode Island since the program was initiated could be attributed to this groundbreaking program – imagine what it would be like if this program was implemented across the country. We would certainly be open to helping any government agency expand this type of program in their own state.

Another way to address the crisis would be to shift responsibility for care from hospitals to dedicated opioid treatment providers. In R.I., we are working on improving a system of referral that will move patients from the hospital ER, directly into treatment from a specialized provider. In the last few years, as part of an effort to enhance immediate access to treatment, all of CODAC’s locations have made a commitment to make care available within 24 hours, seven days a week.

Finally, I believe that increasing the reimbursement rate for treatment services provided by nonprofits would enable them to offer more comprehensive care to more individuals. Of course CODAC provides treatment to anyone who needs it, but adequate and/or timely reimbursement would make it easier to provide the full range of services that are part of effective treatment and recovery plans. This issue has become more pressing at a time when demand for services is rising at a seemingly exponential rate.

PBN: Which part of this epidemic does the Rally4Recovery event address?

HURLEY: Rally4Recovery is organized to celebrate people in recovery and the friends, families and care givers who support them. It is typically held at multiple locations throughout September as part of National Recovery Month.  Over the last few years, the event has grown from a few dozen people to thousands of attendees, a clear reflection of the opioid epidemic’s impact – and a powerful example of the number of people taking ownership of their lives, as individuals and as members of a proud and vibrant community.

One of the highlights of this event is that it invites the public to see this community as people like themselves – individuals from all walks of life standing in solidarity against the disease of addiction. The event also showcases the wide range of recovery resources available to them throughout the state.

With that in mind, Rally4Recovery directly addresses the stigma associated with substance use disorder. The event provides a positive, public platform for people to discuss the challenges they have faced without the fear or shame that often accompanies that dialogue.

PBN: Please tell us more about CODAC’s new initiative addressing the issue.

HURLEY: I can’t say too much about our latest initiative, but I can tell you that we are working with R.I. State Police to roll out the Hope Initiative later this month. The program will pair law enforcement officers with a counselor and peer recovery specialist for emergency calls involving potential opioid use. A second part of the same initiative involves giving people rides home after being released from a correctional facility – a period when former inmates are at the highest risk of overdosing.

PBN: Can you share a story that illustrates the most important part of the problem?

HURLEY: One of the less-talked about and most important parts of the opioid crisis is the lack of housing opportunities for people living with a substance use disorder.

Speaking from our own experience, stable housing is critical to almost all aspects of a successful recovery. The problem begins the moment people are released from prison with no money or place to live, which poses a conundrum because those are typically required to secure stable employment.

CODAC’s staff has worked relentlessly to remedy this widespread dilemma and we are fortunate to have recently acquired a grant that addresses this issue. The grant provides funding for inmates being released from the ACI to temporarily live in licensed recovery houses. Depending on their circumstances, patients can have transitional housing expenses funded for up to four weeks. This same grant also provides short-term subsidies for transportation costs to help patients get to the services and resources they need in the community.

To illustrate the impact this initiative is already making, I want to share a story of an individual who was referred to one of our locations. John Murphy, a pseudonym to protect our patient’s privacy, was released from the R.I. Department of Corrections and, like many former inmates, he stepped foot outside the barbed prison fence for the first time in many years without money or a place to live.

Murphy had another problem, however. He had an addiction to opioids and without the ability to continue receiving the medication assisted treatment he received while in prison, it is likely he would have fallen into the same vicious cycle of being re-incarcerated, or worse, experiencing an overdose.

John’s story of addiction began the same way it begins for many – being prescribed medications to treat pain. He acknowledges that addiction still has a grip on his life and without MAT, he noted he would likely be back in prison. After release, Murphy was able to secure disability benefits for an injury sustained when he was younger. With that money available to him, he took the initiative to sign into a recovery house, he began participating in yoga and other wellness programs, and most importantly, he claimed ownership of his overall health and well-being.

The point of this story is that given the resources to secure stable housing and facilitate transportation, individuals with a substance use disorder are more likely to help themselves achieve lasting recovery. The challenge remains in finding a consistent, reliable source of funding for programs that we know would make a difference in people’s lives. Murphy’s story is one among many that illustrates how a little additional support early in the recovery process can have a big impact on long-term recovery.

Rob Borkowski is a PBN staff writer. Email him at Borkowski@PBN.com.